New York:

Strike at Smithtown Hospital
by Barbara J. Durkin, Newsday, November 27, 2001


Nurses at St. Catherine of Siena Medical Center in Smithtown went on strike yesterday, frustrated over being forced to work mandatory overtime and seeking a new health plan.

Some of the same issues now on the table almost doomed the sale of the hospital (then St. John's Episcopal Hospital) in February 2000, when nurses initially rejected and then grudgingly approved a contract that Catholic Health Services demanded before it would complete its deal to buy the struggling hospital and keep it open.

"They asked us back then to give them a year," said Barbara Crane, a registered nurse at the hospital and president of the hospital's New York State Nurses Association unit, breaking into tears. "We gave them a year and a half, and this is where we end up? They were supposed to be our saviors."

The union, which represents about 475 full-time and part-time nurses, had voted overwhelmingly to strike, and a bargaining session Sunday night failed to produce a last-minute agreement. The nurses have been working without a contract since May.

Hospital officials said yesterday they had brought in more than 100 replacement nurses to staff the hospital and that no cutbacks in service are planned. Hospital president and chief executive Jim Wilson said the hospital had as many nurses working as would be normally needed to take care of the 200 patients staying there.

"It's important for the community to know we are here and we are fully operational and we will continue to take care of their needs," he said.

Both sides cite two areas as major sticking points in negotiations: the nurses' desire to leave the hospital's health plan for a New York State Nurses Association plan and their concern with mandatory overtime.

As nurses walked the picket line yesterday, they complained of routinely being told they would have to work extra hours after they finished eight- to 12-hour shifts to help fill holes in the schedule.

"They're using it as a regular scheduling tool," said Dan Chamberlain, a long-time operating room nurse at the hospital and a member of the union negotiating team. "These floor nurses are getting killed."

While Wilson acknowledged that the hospital does sometimes require mandatory overtime, he said that it accounts for no more than 4 percent of staffing over a typical two-week period.

The problem, he said, is a national nursing shortage. "Recruiting registered nurses has become very, very difficult for every health care provider in the country," he said.

CHS has hired 109 new nurses since taking over the hospital, but union representatives note that it has also lost more than 70 nurses since then. "What they don't understand is what it takes to keep a nurse," Crane said.

Wilson said nurses left for a variety of reasons, including retirement and relocation. "It's not an excessive number given what's going on in the industry," he said.

Wilson also said the overriding issue in the negotiations has been the nurses' wish to join a union-sponsored health plan.

That plan would cost the hospital some $500,000 more annually for a plan that is no better than the one now offered, he said.

Crane said the nurses want to switch because the hospital has changed its benefit package several times and because the union plan may soon offer benefits that continue through retirement.

It's not clear when the sides will meet again; no bargaining sessions are scheduled at this time.

The nurses pledged to stay out as long as necessary.

"We're going to do whatever it takes, for as long as it takes," said Michael Chacon, a nursing representative from New York State Nurses Association.

Copyright © 2001, Newsday, Inc.

Nurses strike at St. Catherine of Siena
by Anna Demian, The Times of Smithtown, St. James and Nesconset, November 30, 2001


During the course of the day on Monday November 26, a total of 430 out of the 474 Registered Nurses (RNs) who work at St. Catherine of Siena Medical Center stood at the hospital¹s entrance on Route 25A. They were there to strike. The nurses, all members of the New York State Nurses Association (NYSNA), want the hospital to put staffing guidelines into their contract, to guarantee the option of flextime, to eliminate the use of mandatory overtime except in emergencies and to change the health benefits package. They have been without a contract since May of 2001.

Hospital officials want the public to know that the hospital is still open and offering all of its services. ³We have the same number of employees providing patient care as before the strike,² said Andy Kraus, a spokesman for St. Catherine¹s. To fill the positions of the striking nurses the hospital has hired 110 full-time replacement nurses.

In regard to the demands of the striking nurses, St. Catherine¹s officials maintain that it is the job of administration to ensure proper staffing levels in the hospital, pointing out that the hospital already has staffing guidelines that have been reviewed and approved by the Joint Commission for Accreditation of Hospitals, a not-for-profit monitoring organization. Officials also point to an incident last year, when the nurses reported concerns about short staffing to the New York State Department of Health (NYSDOH). The NYSDOH investigated and found no evidence of staffing problems.

The nurses at the picket line referred often to mandatory overtime saying that the hospital used it ³liberally² and that it was ³dangerous.²

Said Pat Gillen who has been a nurse in the Emergency Room at St. Catherine¹s for six years, ³Mandatory overtime happens frequently. People come in to work not knowing when they are going to go home.² She continued, ³They work on us through guilt saying that we shouldn¹t leave our coworkers alone. It is administration¹s responsibility [to staff floors] but they put it on our shoulders.²

³[St. John¹s] used to at least guarantee that we could take off the next day if we worked mandatory overtime,² said Barbara McMahon a nurse in the Cardiac Services Unit (CSU). ³Now I might work until one 1:00 am and be expected to come in at 7:00 am the same day.²

St. Catherine¹s spokesman Andy Kraus said that mandatory overtime makes up a no more than 4 percent of all RN overtime in a typical two-week period. ³The hospital understands [mandatory overtime] is a burden and the hospital has been working with NYSNA to reduce its use, [but] sometimes it is a situation where patients need nursing care. They come first.²

Kraus said that the option of a day off after mandatory overtime was eliminated because it was found to create the need for more mandatory overtime. He added that nurses must be off for at least ten hours after a mandatory overtime shift.

The nurses also want the hospital to guarantee that flextime, a staffing option where nurses work three 12-hour shifts a week instead of five eight-hour shifts, will not be eliminated. Currently flextime is offered to nurses on some floors in the hospital.

³It is one of the benefits to coming into this field,² said Tom Gorman, a nurse in the psychiatry wing. Many nurses value the flextime option as it allows them to spend more time with their families. It also allows for greater continuity in patient care.

Kraus said that the hospital does not intend to eliminate flextime where it is already available. He added that the hospital was willing to expand the flextime program in the future, but said that the hospital could not offer the flextime guarantee that the nurses wanted because of their responsibility to make sure the hospital is fully staffed at all times.

In addition to staffing issues the nurses are asking the hospital to switch from the current health benefits plan to one provided by NYSNA saying that the new plan offers a lower co-pay and the possibility of retirement benefits. The nurses also believe that a better benefits package would help the hospital to attract and keep new nurses during a worldwide nursing shortage. Hospital officials said the yearly cost to switch would be close to $500,000. ³We simply can¹t afford it,² said hospital spokeswoman Pat Stickle.

The St. Catherine¹s administrators said that the hospital has been actively trying to recruit nurses since Catholic Health Services bought the facility from Episcopal Health Services in 2000. The hospital has hired 110 new nurses since the takeover; however, 70 nurses have left the hospital in the same time period, leaving the increase in nurses at around 30. ³The hospital does not think this is an excessive turnover rate,² said Kraus.

The nurses served the hospital with notice to strike on Thursday, November 15. After last minute negotiations on Sunday, November 25, failed to bring about an agreement the nurses officially began picketing on the 26th. For now, negotiations are at a standstill with no meetings scheduled for the future.
³The hospital and the union have been negotiating since May,² said Kraus. ³During that period a number of tentative agreements have been reached. The hospital is interested in getting back to the table.² Kraus would not discuss specific details of the negotiations saying that he preferred not negotiate through the press.

It is unclear how long the nurses will be on strike. ³We are going to keep striking [until we have an acceptable contract],² said R.N. Barbara Crane. ³Most of the nurses have found per diem work and we are going to see this through.² When asked why the nurses did not find other jobs, Crane said, ³We are vested in this place. I don¹t see why we should have to pick up and walk away.²

Ackerman stands by nurses of St. Catherine of Siena in Smithtown - NYSNA, December 1, 2001 <http://www.house.gov/ackerman/press/nursestrike.htm>

Striking nurses hold vigil - News12.com, December 7, 2001
<http://www.news12.com/CDA/Articles/View/0,2049,5-5-27801-20,00.html>

Striking Nurses Not Hurting for Jobs - Barbara J. Durkin, Newsday, December 7, 2001
<http://www.newsday.com/news/local/longisland/ny-linurs1207.story>

Nurses, hospital back at the bargaining table -
Anna Demian, Times of Smithtown, St. James & Nesconset, December 12, 2001
<http://www.tbrnewspapers.com/news/ssn1.html#ssnstory>

Hundreds of jobs will be cut at NUMC - news12.com, December 17, 2001
<http://www.news12.com/CDA/Articles/View/0,2049,5-5-28549-20,00.html>

Will health care hold up after cuts? - news12.com, December 17, 2001
<http://www.news12.com/CDA/Articles/View/0,2049,5-5-28542-20,00.html>

St. Catherine of Siena Medical Center Strike - NYSNA, Daily Updates
<http://www.nysna.org/NEWS/current/stcath.htm>

Oregon:

Strike Begins Monday: Nurses Vote: 72% rejection of OHSU contract
<http://www.fairpay4nurses.org>
Oregon Nurses Association, December 15, 2001


PORTLAND, Ore.- A majority of OHSU nurses have voted today (Saturday, December 15 2001) to reject OHSU's latest and final contract offer to its 1500 registered nurses. More than 1,100 nurses cast ballots throughout the day (more than the previous vote). With the rejection of OHSU's last and final contract offer, the nurses will stop work and walk off the job at 7:30 AM, Monday, December 17th. "The nurses today have overwhelmingly rejected OHSU management¹s offer. They are sending a message to management that they require respect, compensation and more attention to quality patient care. Starting Monday, they will see their nurses walk off the job in protest of their treatment and their patients treatment," said Kathleen Sheridan, ONA labor negotiator. ...

Nurses at OHSU give OK to strike - Joe Rojas-Burke, The Oregonian, November 30, 2001
<http://www.oregonlive.com/business/oregonian/index.ssf?/xml/story.ssf/html_standard.xsl?/base/business/10071249504326110.xml>

Nurses get revised offer from OHSU - Joe Rojas-Burke, The Oregonian, December 15, 2001
<http://www.oregonlive.com/news/oregonian/index.ssf?/xml/story.ssf/html_standard.xsl?/base/front_page/100842093723622138.xml>

Walkout by nurses could be lengthy - Joe Rojas-Burke, The Oregonian, December 17, 2001
<http://www.oregonlive.com/news/oregonian/index.ssf?/xml/story.ssf/html_standard.xsl?/base/front_page/10085937321804188.xml>

OHSU adjusts as nurses picket - Joe Rojas-Burke & Wendy Lawton, The Oregonian, December 18, 2001
<http://www.oregonlive.com/news/oregonian/index.ssf?/xml/story.ssf/html_standard.xsl?/base/front_page/10086801253137389.xml>

OHSU keeps going, but not without problems - Don Colburn, OregonLive.com, December 18, 2001
<http://www.oregonlive.com/news/oregonian/index.ssf?/xml/story.ssf/html_standard.xsl?/base/news/100868013231373116.xml>

New England Roundup:

ERs say no when beds are scarce: In many cases, care is delayed - Raja Mishra, Boston Globe, December 10, 2001
<http://www.boston.com/dailyglobe2/344/metro/Ers_say_no_when_beds_are_scarce+.shtml>

Organized Nursing Responds:

Fix ER woes by hiring nurses


A Globe story on ER diversions (³ERs say no when beds are scarce,² City & Region, Dec 10) focused attention on a growing health care crisis. However, the officials quoted in the story underplayed the most significant cause of the problem. Yes, there is a shortage of beds in the system, but the more immediate cause of diversion today is a shortage of nurses to staff existing beds, particularly nurses to staff beds in intensive care units.

It is interesting that the story cites Mass. General as one hospital that has successfully reduced diversions. How? They hired nurses.

Fortunately, this problem can be solved. Massachusetts has the fourth highest per capita population of nurses in the nation. The problem is, most of them have been removed from the bedside by a decade of cost cutting by hospitals, or still more have left because of deplorable working conditions that prevent them from practicing their profession safely.

Legislation is now pending that would stimulate recruitment of nurses through funding for nursing scholarships, loan forgiveness and mentorship programs. Another bill would mandate safe staffing levels and conditions that would retain desperately needed nurses who are now leaving in droves. Unless we address the shortage of nurses, the diversion problem will continue and patients will suffer.

Karen Higgins, RN
President, Massachusetts Nurses Association
Boston Globe, December 17, 2001

Mental health budget slashed: Hundreds could lose care
by Sue Reinert, The Patriot Ledger, November 28, 2001


The state's mental health commissioner says the new state budget will force hundreds of mental patients out on the street and leave others stuck in hospital beds because there is no place for them to go.

Beginning Saturday, the state will put a temporary hold on all new requests for mental health services because of "staggering" budget cuts, Mental Health Commissioner MaryLou Sudders said yesterday.

She said the budget cuts in the new state budget will result in massive layoffs and shutdowns. "I can't be bringing in new patients when I'm discharging people," Sudders said. "I will temporarily halt any new eligibility-for-services evaluations until I have a sense of what the final budget is."

The reviews are the first step in obtaining counseling and other services from the state. Sudders said the suspension will apply to both children and adults who request help.

Also Saturday, state mental hospitals will stop accepting transfers of adult mental patients from general hospitals and private psychiatric hospitals, Sudders said.

"I can't be taking people in when I am going to (lay off employees)," she said. The state takes about 600 patients a year from other psychiatric facilities, she said.

After delaying a vote on the state budget for months, legislators agreed Nov. 21 to slash spending by $650 million, with about $450 million coming out of human services.

The Legislature cut $21.8 million from a mental health budget of about $618 million, Sudders said. But because the reduction comes halfway through the fiscal year, after agencies have been spending at a higher level, the impact will be twice as great, she said.

"This is huge," she said. "This is like $42 million."

Acting Gov. Jane Swift intends to present a supplemental budget, which may restore some of the money, Sudders said. But unless legislators approve it, mental patients and their families face significant loss of services, she said.

Among the cutbacks:

‹The state will close 58 of its 342 residential beds for children, mostly in group homes. That will force 58 mentally ill children into their communities without any support and increase the problem of children "stuck" in hospital beds because there is no community treatment available, Sudders said.

‹Nine wards in Medfield, Worcester, Westboro and Taunton State Hospitals will close, forcing 170 adult patients onto the street without services. "If they have families we will be asking families to take them home," Sudders said. Otherwise, they may be discharged to a shelter, she said.

‹A total of 334 residential beds for adults, including 160 for homeless people, will close, leaving those seriously ill patients on the street without services.

‹Cuts in a program to find residential placements for adults stuck in hospital beds mean that 170 hospital patients will remain there, Sudders said. The department had been trying to find community beds after advocates threatened a lawsuit, she said.

‹The state will cut 40 percent of funding for mentally ill jail inmates. The money went to sheriffs to supplement county funding, Sudders said.

‹The department will lay off 597 full-time-equivalent employees, or about 12 percent of its work force, Sudders said. Administration cuts alone amount to 21 percent, or 128 full-time-equivalents.

Although it was clear that the state had to make deep cuts to deal with the economic downturn, "I was stunned by the (final) budget," Sudders said.

Swift has said she will veto some spending items and submit a supplemental budget to restore some cuts. No decision has been made on the mental health outlay, but Sudders said the reduced budget proposed by Swift shortly before the Legislature acted still included $615.8 million for the department.

Sue Reinert may be reached at sreinert@ledger.com.

Copyright 2001 The Patriot Ledger


NARH nurses, administrators dispute effects of cuts in staff           
by Susan Bush, Berkshire Eagle, December 01, 2001


NORTH ADAMS -- The job cuts and other changes under way at North Adams Regional Hospital are either a necessary part of an ongoing transition or a damaging setback, depending on who's talking.

The transition, involving registered nurse and other staff layoffs, changes in the delivery of health care services, and the eventual creation of a short-stay unit at the hospital, began this week.

The transition is deemed necessary and beneficial for patients by hospital administrators, while some nurses view the changes, especially the cuts in their ranks, as detrimental to patient care.

Mary McConnell, a registered nurse and chairwoman of the local chapter of the Massachusetts Nursing Association union, and John C.J. Cronin, president of the hospital, offered their viewpoints earlier this week.

The layoffs began Monday, when fewer nurses were on duty, and continued Wednesday, with licensed practical nurses, certified nursing assistants, and additional support staff represented by the Service Employees International Union facing job elimination or working reduced hours.

Problems already

Problems with RN staffing have already begun, according to McConnell, who said that on Tuesday reduced staffing in the surgical recovery room caused people to begin the recovery process while still in the operating room. According to McConnell, the two registered nurses on duty were unable to care for all the patients, and could not accept post-operative patients twice during that day.

Patient transport was also a problem, she said, saying that an operating room nurse had to leave the operating room to retrieve a patient from another floor. The medical-surgical unit was hit with 10 admissions Tuesday, and nurses working that unit accrued overtime, she said.

"I think every nurse had to stay late, even though we have no mandatory overtime language [in the current contract]," she said. "But you can't just walk away from a patient needing care."

Nurses have been called in on their days off to work and those who lost their jobs on one unit but secured another position through the "bumping" process have been asked to remain at their original jobs until mid-December, postponing orientation on their new units, McConnell said.

Cronin said the incidents described by McConnell also occurred prior to the layoffs, and are part of normal hospital routine. The transition may be exacerbating certain situations, but care is not being compromised, he said.

"We have huge fluctuations in admissions," he said. "Sometimes we admit three, sometimes 10, sometimes 15. We staff for our average. When we encounter a day when it is higher, we call staff in. On days when it is lower, we send staff home."

Both McConnell and Cronin stressed that layoffs are just beginning, but each anticipates a different end result.

"The full scope of this has not been felt yet because some nurses that were laid off have been asked to stay on their unit," McConnell said. "But these are things that are happening on our very first week. This was just a normal day in a busy community hospital. Some people at the hospital feel we are scaring the public. Well, the public should be scared."

Cronin said certain issues will probably arise as the transition continues, but there is no question quality patient care is being delivered.

"The orientation and bumping is all part of the transition," Cronin said. "The issues are part of the process. We are not compromising patient care. And even in these emotional times, our staff has conducted themselves very professionally. We are trying to provide the very best care we can for this community, and I know this plan will result in that, and this team and staff will do that."

According to Cronin, strides in medical technology and medications have changed how nurses function, and the hospital is simply reacting to health care improvements. While ideally every patient would have his or her own nurse, the financial reality disallows such scenarios.

Between 1995 and 2000, patient admissions in the Berkshire area dropped by 14.6 percent, with statewide admissions declining by 15.9 percent, according to Cronin. And when someone is admitted, the stay is shorter than in years past, he said.

"This is what drives the workload for our care-giving staff, including our RNs," he said.

According to Cronin, even with the layoffs, there will be more registered nurses present than in 1996. The short-stay unit is advertising for six registered nurses, four at 16 hours a week and two at 24 hours a week, and overall care is being increased over time, he said.

And while the initial layoff announcement predicted the equivalent of 27 full-time RNs would be laid off, because of the bumping process, only 11 will be left without jobs, Cronin said. He acknowledged that most open positions are part-time.

"Part of what is driving this is the financial impact on health care services," Cronin said. "Medicaid, Medicare -- nobody wants to pay."

He repeated his frequent criticism of the state Medicaid reimbursement schedule of 70 cents on the dollar, and the $6 million in federal Medicare reimbursement revenues being lost at NARH because of the Balanced Budget Act of 1997. The act slashed reimbursements for the five years between 1997 and 2002.

"When you have these financial pressures, you have to match workload to patients," he said.

"We want to be here to provide care. No one has the resources to do what they did in the good old days. We had layoffs due to the economic environment and we did them in a way that was sensitive to the changes in delivering care. We are providing safe care with this model, a higher level of care. But we've had to restructure."

More than jobs have changed, McConnell said. Staff continuity has been threatened by the constant threat of even more change resulting in more job cuts.

"If you are young and you have to worry about a layoff every October or November, you will find another job and you won't come back," she said, emphasizing the benefits of a long-term, experienced nursing staff.

The staff shortages generated an MNA meeting earlier in the week, during which ways to protect RN licenses was discussed, she said.

"Nobody wants to be the nurse on duty if something catastrophic happens," she said. "I have encouraged every nurse to fill out an unsafe staffing form when they encounter an unsafe assignment or situation."

Cronin said he believes three forms have been filed so far.

RNs want to give the best care they can, a desire driven by compassion and skill, not finances, McConnell said.

"When you are presented with a budget that cuts health care services to patients, you need to question it more closely," she said.

"Specialty areas, such as the operating room, the emergency room, the critical care unit have very stringent standards and those standards are not being met right now. These people want to give the best care, that is what they do, but it's next to impossible. It's very difficult to give good care when you are overwhelmed and understaffed. We have openly said if a hospital cannot be properly staffed, it should close."

NARH serves a multitude of people from North Adams, Adams, Williamstown and surrounding communities in an exceptional manner, and should not close, Cronin said. Patients will be the winners with the changes, and the best care is currently being delivered by the best professional staff, he said.

"We have a wonderful professional nursing staff and that is not a change," he said.

McConnell said she is concerned about nurses and patients alike.

"We are not trying to scare people for the sake of our jobs," she said, noting that she knows of at least two nurses who have already found full-time employment at other facilities.

Susan Bush can be reached via e-mail at SBush@berkshireeagle.com

© 1999-2001 by MediaNews Group, Inc. and New England Newspapers, Inc


Nurses must suffer for NARH blunders


November 18, 2001
To the Editor of THE EAGLE:

In business and sports, when operating in the red, it is usually the CEOs and managers who take the blame; the theory being it is more practical to fire the leaders than the whole team. In point of fact, it is the captain's job to steer the ship. If it goes off course, whose fault is it?

Why hire consultants at great cost? Isn't that the CEO's job? Why hire more high level administrators to supervise the day to day operation of the hospital? Isn't that the CEO's job? Why hire nurses, pay them a $5,000 bonus and before a year is up, lay them off? Why lay off and cut hours of nurses in the midst of a nation-wide nursing shortage?

North Adams Regional Hospital tells us the only way to solve this fiscal mess is to lay off nurses, nurses who care for patients, but we wonder, in view of the financial problems, whose fault is it?

Danielle Trottier
Judith Brolin
Martha Siciliano
Anne T. Haun

North Adams, Nov. 12, 2001
The authors are registered nurses at NARH


When did healing become an industry?
by Marion Reed, RN, For The Patriot Ledger, December 4, 2001


"Not everything that counts can be counted." - Dr. Denis Burkit

Twenty-five years ago I became a nurse. Like all novices, I was initiated into the language of my new profession - the jargon of nursing and medicine and social work.

I discovered the differences between "po" and "IV" and "IM." I learned when to say "STAT" and - equally important - when not to say it. I watched families struggle with the decision to make a loved one "DNR."

Over time, I was called upon to master new language. This wasn't the language I had been taught, but the language of business. Business principles entered my world and healing became, mysteriously, the "health care industry."

Words like "spreadsheet" and "bottom line" and "reduction in force" crept into my world and I struggled with these new ideas and struggled to see them as part of my practice. There were times when they had no place there, when healing and business had no overlap.

Recently I was again reminded of this dissonance. In the out-patient mental health clinic where I now work, my colleagues and I were given our productivity statistics. This is a periodic event for us and one I find oddly stressful. It reminds me of receiving report cards in elementary school.

Then, as now, my work is evaluated, my performance appraised. How well or poorly I have done is right out there on the paper in black and white. It's there for me and others to see. Parents, teachers and bosses can see it, critique it and, possibly, tell me that I'm "not working to potential."

I scrutinized the numbers on the paper trying to make sense of their meaning. As I studied the numbers, the truth slowly dawned. These numbers would never make sense because of what they are. They are numbers. They are symbols of mathematical precision. They are the language of business. They are not the language of my work or the work of my colleagues.

I glanced at my colleagues and pondered the truth. Our work is not measured in numerals. I know this not only because it is my work, but also because my colleagues have been generous enough to share their work with me.

They've told me the stories. I've heard about group meetings where people who believed their lives to be hopeless reported a glimmer of hope. The group members cried tears of joy and so did we. I've heard about family meetings where parents and children talked to one another after years of silence and hurt. I have heard about lives turned around. I've seen letters of gratitude for lives that now have meaning and purpose, free from the enslavement of addiction.

I've seen depression lift and psychosis abate due to their skilled use of medications. I've watched disorganized, dulled people regain mastery and a new spring in their step. I've heard mute, forlorn souls begin to talk and even to laugh.

I know about some of the things they do because I've seen it. I know how they made the extra effort, endured the near-intolerable expression of grief and said no when saying yes would have been easier. I know the times they could have given up but did not, the times they worried, the times they cried and the times they rejoiced with their patients' successes.

I've learned from them, so much more than books could ever teach. I've valued their experience and their knowledge. They have graciously shared it and enriched my world. They've supported me in my work as I have tried to support them.

This is not the stuff of numbers. We will continue to be presented with numbers. There may even be a way that they can be useful. They can cause us to pause, to think and to problem-solve. They do not, however, come even close to evaluating what it is we do.

Our work can never be described numerically. Even words are inadequate. Business language isn't applicable to our work of healing. It is now part of our world and we can try to make it work for us and for our patients. It behooves us to understand it enough to help us reach our goals.

But let us never be fooled into thinking that it can quantify our work.

Our work is deep and rich and full of layers of meaning for us and for our patients. It is a mysterious mix of art and science. For those to whom we make a difference, it is valuable beyond any measure.

So, let us glance at the numbers and recognize them for what they are and for what they are not. Let us give the numbers a brief moment and then turn our attention back to our patients and get back to our work of healing.

Marion Reed is a writer who lives in Norwell.

Copyright 2001 The Patriot Ledger


State won't help workers bring assault charges
by Sue Reinert, The Patriot Ledger, December 7, 2001


Recent assaults by mental health patients on nurses in Quincy and Pembroke have called attention to a new policy that discourages state employees from taking such cases to court.

On May 10, Commissioner of Mental Health MaryLou Sudders issued a directive that said her department will never seek a criminal complaint against a patient who assaults a state employee, and will not help the employee bring charges.

Anna Chinappi, a spokeswoman for the agency, said, "There had been several incidents prior to this, and people in the field were asking for guidance."

Employees who decide to seek a complaint on their own must first inform the head of their facility and discuss with managers "the competing ethical, clinical and legal issues which are raised by the situation," according to the policy.

Chinappi said the procedure is "a good balance" between those who oppose prosecuting any patient because an offense is "part of their illness" and those who believe patients should be held responsible for their behavior.

Sudders said the policy doesn't prevent an employee from going to police or the courts.

But union officials said the policy discourages complaints. The department should focus instead on preventing violence against workers, "especially increasing the numbers of staff," said Evelyn Bain, associate director of the Massachusetts Nurses Association, which represents nurses in state-run psychiatric facilities.

The conflict over whether to prosecute mental patients for assaults on workers has also showed up in the courts.

Three months ago, a 30-year-old male patient at Pembroke Hospital was accused of beating a nurse so severely that the nurse was hospitalized for more than a week.

Pembroke police filed an assault complaint in Plymouth District Court in early September, but Clerk Magistrate John Sullivan delayed a decision while he waited to see if a court in Attleboro, in a separate case involving the patient, would order him committed.

The patient later agreed to a voluntary commitment. Now Sullivan has asked a psychiatrist to evaluate him for criminal responsibility.

"His mental state is key in deciding his criminal intent," Sullivan said. "Criminal intent is a factor in determining probable cause for issuing criminal charges."

The Pembroke case, because it involves a private hospital, would not fall under the Department of Mental Health policy.

Quincy Mental Health Center, however, is a state facility.

A former Quincy Mental Health Center patient is scheduled to go to trial Jan. 4 on a charge of assault and battery with a dangerous weapon.

The female patient is charged with stabbing nurse Charles Belanger with a pen May 13. She also is accused of biting another nurse on the same day.

Belanger said he and his supervisor didn't know about the new policy, which was issued three days before the attack. The supervisor helped him press charges, he said.

Nurses say the attitude at the Quincy court has improved.

Two years ago, a court clerk declined to issue a criminal complaint against a Quincy Mental Health Center patient who beat a nurse into unconsciousness, said Leslie Sullivan of Braintree, co-chairman of the Massachusetts Nurses Association Task Force on Workplace Violence.

The clerk told the nurse, "ŒIt's part of your job,'" Sullivan said.

When the nurse appealed, a judge issued the complaint, but not without scolding her, Sullivan said. The patient went to trial and was sentenced to a year of probation, "which is what we wanted," Sullivan said.

Sullivan and other task force members later met with Chief Justice Barbara Dortch-Okara, head administrator of the district courts, to ask that court officials take violence against health-care workers more seriously.

"It was an eye-opener to me," Dortch-Okara said.

After hearing from the nurses, she talked about the issue at a regular meeting of district court chief judges in January, she said.

"As I expected, the chiefs had not heard that this was a matter of concern or that this kind of violence was on the rise," Dortch-Okara said. "Their sensitivity to the issue was heightened."

Nurses in every area of health care, not just mental health, are potential victims of violence, Sullivan said.

"Basically, nurses have been injured for many years, and it was always considered part of the job," she said.

No statistics for Massachusetts are available. Nationwide, about 200,000 health-care workers were assaulted annually between 1992 and 1996, according to the Massachusetts Nurses Association, which cited a federal study.

That is approximately the same frequency of assault experienced by law enforcement employees, the study says.

Although mental patients, on average, "have no more propensity to violence than a normal person," some are more violent, Sullivan said.

Every nurse working at Quincy Mental Health Center has been assaulted at least once, she said. Sullivan said she previously worked at the health center.

Staffing cuts and double shifts increase the danger to workers, nurses say.

Bain, the Massachusetts Nurses Association's associate director, said the association has filed legislation that would make assaulting a health-care worker a felony instead of a misdemeanor. Assaulting a doctor is already a felony, she said.
Staff reporter Tamara Race contributed to this story.

Sue Reinert may be reached at sreinert@ledger.com.

Copyright 2001 The Patriot Ledger


Court to weigh nurses¹ case

Hanover school ruling could increase pays
by Alisha Berger, The Patriot Ledger, December 4, 2001


BOSTON - Hanover public school nurses yesterday asked the state¹s highest court to uphold a Superior Court ruling that would increase their salaries and potentially the salaries of school nurses across the state.

In 1996, the school committee recognized the Hanover Teachers Association (HTA) as the bargaining agent for the nurses. Once the nurses were admitted to the HTA, they argued they should automatically be paid the same as teachers.

At the time, the Hanover School Committee argued that even though they were negotiating with the HTA, the nurses contract should be separate from that of the teachers.

High school nurse Patricia Stone, who attended yesterday¹s hearing, earns $34,000 but would receive almost $52,000 if the court rules in favor of the nurses.

³We hope we¹re going to win this not only for Hanover nurses, but for nurses throughout Massachusetts.²

Nurses in nearly 25 other communities are watching the case because their salaries could be affected by the ruling.

In 1998, a state-appointed arbitrator ruled in favor of paying the nurses on the same scale as teachers.

Attorney Paul Kingston represented the Hanover school committee before the Supreme Court yesterday. He said when the labor commission agreed that nurses should be part of the teachers¹ bargaining unit, it didn¹t mean the teachers¹ contract automatically applied to them.

³We had an obligation to negotiate,² he said. ³The fact that an arbitrator ruled against us means that he exceeded his authority.²

Kingston argued that the arbitrators stripped the school committee of its right to negotiate.

Attorney Matthew Jones represented the HTA and said the arbitrators acted within their power.

Teachers earn roughly $30,000 to $72,000, while nurses earn between $25,000 and $33,000 annually. The court is expected to rule within 130 days.

Alisha Berger may be reached at aberger@ledger.com.

Tolman qualifies for Clean Elections - Associated Press, November 14, 2001
<http://www.gazettenet.com/11142001/politics/8566.htm>

Gubernatorial candidate files 'Clean Elections' forms
- Associated Press, November 26, 2001
<http://www.boston.com/dailynews/330/region/Gubernatorial_candidate_files_:.shtml>

Tolman protests at Finneran home - Boston Herald, November 27, 2001
<http://www.bostonherald.com/news/local_regional/lnib211272001.htm>

Vouching for a larger issue - Adrian Walker, Boston Globe, December 3, 2001
<http://www.boston.com/dailyglobe2/337/metro/Vouching_for_a_larger_issue+.shtml>

Seniors Scrambling To Replace Health Plans -
Diane Levick, Hartford Courant, December 9 2001
<http://www.ctnow.com/templates/misc/printstory.jsp?slug=hc%2Dmedhmos%2Eartdec09>

Diagnosis without a cure: Health care committee wraps, offering mixed results -
Jennifer Heldt Powell, Boston Herald, December 10, 2001
<http://www.businesstoday.com/business/business/heal12102001.htm>

Deaconess-Waltham officials would also consider partnership - Michell Hillman, Metrowest Daily News, December 13, 2001
<http://www.townonline.com/tol/news/health/32951176.htm>

Hospital(s) for sale - Steve Bailey, Boston Globe, December 14, 2001
<http://www.boston.com/dailyglobe2/348/business/Hospital_s_for_sale+.shtml>

Acadia¹s woes tied to EMH: 2 quit over management issues - Michael O'D. Moore, Bangor Daily News, December 15, 2001
<http://www.bangornews.com/editorialnews/article.html?ID=47341>

Quality nursing care - Judith Brown, RN, CCRN, Bangor Daily News, December 15, 2001
<http://www.bangornews.com/editorialnews/article.html?ID=47353>

Devotion to themselves - Eileen McNamara, Boston Globe Staff, December 16, 2001
<http://www.boston.com/dailyglobe2/350/metro/Devotion_to_themselves+.shtml>

-------------------------------------

Web Directory:

Sandy¹s Links                                               <http://users.rcn.com/wbumpus/sandy>
Massachusetts Nurses Association                    <http://www.massnurses.org>
California Nurses Association                           <http://www.califnurses.org>
PA Assoc. of Staff Nurses & Allied Professionals  <http://www.calnurse.org/cna/pasnap/index.html>
United Health Care Workers                            <http://www.uhcw.org>
Canadian Federation of Nurses Unions               <http://www.nursesunions.ca>
Australian Nursing Federation                          <http://www.anf.org.au>
Revolution Magazine                                     <http://www.revolutionmag.com>
LabourStart                                                <http://www.labourstart.org>
Union Web Services                                     <http://www.unionwebservices.com>
Rev. Assoc. of the Women of Afghanistan        <http://rawa.false.net/index.html>

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